STRAIN COUNTERSTRAIN
14.1.2013 Lecture no.1 - Lower back, SIJ and piriformis
I have been familiar with the concept of the strain counterstrain for a while and seen this technique being used in the clinic on the acute patients to relieve the muscle spasm and locked up back. the main thing is that the patient needs to stay passive during the whole time of applying of the technique. The tutor showed us how to find L5 anterior tender point just laterally to the pubis symphysis, tender point for SIJ that was on the ramus of the pubic bone, psoas tender point just medially to the ASIS, posterior tender points for extension strains along SPs and TPs of the lumbar spine and for L5 also just superiorly and inferiorly to the PSIS. More medial is the tender point, only flexion is applied. More lateral is the lesion, more sidebending and rotation is needed to be added to the flexion.
So the rule of the thumb is that flexion strain affects the ant. muscles and thus we are looking for anterior tender point and extension strains effect the posterior muscles and tender points can be found posteriorly. The only EXCEPTION is piriformis muscle which is treated in the sidelying position, with the leg adducted and flexed in the hip and either internally or externally rotated. Rotation needs to be probed to see which relieves the tenderness of the tender point. Then keep the patient in the position of release for 90 seconds.
So the rule of the thumb is that flexion strain affects the ant. muscles and thus we are looking for anterior tender point and extension strains effect the posterior muscles and tender points can be found posteriorly. The only EXCEPTION is piriformis muscle which is treated in the sidelying position, with the leg adducted and flexed in the hip and either internally or externally rotated. Rotation needs to be probed to see which relieves the tenderness of the tender point. Then keep the patient in the position of release for 90 seconds.
28.1.2013 Lecture no.2 - Posterior and anterior cervical spine tender points
On the beginning of today's lecture we went through the stuff from last week. The tutor also asked if any of us managed to use the taught techniques in the clinic in the mean while. I have told her about my builder patient that had a muscle spasm of right tensor fascia latta and associated gluteal muscles. I have described to her how unsuccessful I was in my attempt to relieve him from the pain. She showed to us a tender point for this purpose that is located 1/3 down the length of the ITB. Patient is supine, on the plinth the lower extremity is abducted while we press on the tender point. then either try to flex of extend the lower extremity (knee is bent and hanging off the plinth) and ask patient when they do not feel the pain. that position is then held for 90 seconds.
Then we talked about the posterior and anterior tender points which are highlighted in the handout (see my folder). The tutor used her bent knee as the support for the head held in the flexion when accessing the anterior tender points. we also talked about the supraorbital tender points that are usually tender when a patient complains of the cold and cough. once these are confirmed and tender, one hand holding on the bridge of the nose and pulling it down, and the other hand pushing on the frontal bone up, can help to relieve sinusis blocked. this can be also done by the patients at home by sitting above the table, the weight of the hand in the hand placed on the frontal bone and the other hand pulling down on the bridge of the nose. hold this position for 90 seconds.
Then we talked about the posterior and anterior tender points which are highlighted in the handout (see my folder). The tutor used her bent knee as the support for the head held in the flexion when accessing the anterior tender points. we also talked about the supraorbital tender points that are usually tender when a patient complains of the cold and cough. once these are confirmed and tender, one hand holding on the bridge of the nose and pulling it down, and the other hand pushing on the frontal bone up, can help to relieve sinusis blocked. this can be also done by the patients at home by sitting above the table, the weight of the hand in the hand placed on the frontal bone and the other hand pulling down on the bridge of the nose. hold this position for 90 seconds.
11.2.2013 Lecture no.3 - Thorax and ribs tender points
it was a very good stuff to recap and go through the techniques from the last week. I worked with MG and she explained for revision all the tender points of the CSp posteriorly. the points for C1 can be on SP, articular pillar, around the mastoid bone or on the angle of the mandible. C8 point anteriorly on the notch of the sternum. the tender points of the TSp posteriorly are over the corresponding SP or TP and for ribs on the angles of the ribs (posteriorly). Positioning patient sidelying and extending them while palpating the tender point is required. For ribs add shoulder rotation while spine is extended. Anterior points are along the midline on sternum and then above and below the umbilicus (for T 10 and T 11). the patient positioned on the plinth with head end lifted up or with the leg (knee) of the practitioner supporting spine in flexion. for ribs anteriorly add pillow under the shoulder to bring in forward to achieve sidebending and rotation towards the lesion. we also went through the upper ribs (rib 1 specifically) in seated position. Patient positions their UEx on the uneffected side on the practitioner's thigh (foot is on the plinth). Patient is sideshifted towards rotated and sidebent (also the head plus neck)towards the affected rib.
I realised that practicing is the best way how to learn. I could feel that the techniques are very effective as i felt myself much better. I tried to work with variety morphologies this time.
We also tried on each other skin rolling. the most painful experience ever but sooo effective.
on the end of the session we were shown the biceps, lev scap and supraspinatus tender points and their release. patient on the back, for biceps release flex shoulder, elbow flexion, external rotation, put the back of the hand on the forehead of the patients head. press on biceps tendon. supraspinatus - upper extremity 45 degrees abduction, 45 degrees flexion and external rotation. push on the upper extremity superiorly. for lev scap abduct the upper extremity and shorten the lev scap by pushing on the upper extremity superiorly.
I realised that practicing is the best way how to learn. I could feel that the techniques are very effective as i felt myself much better. I tried to work with variety morphologies this time.
We also tried on each other skin rolling. the most painful experience ever but sooo effective.
on the end of the session we were shown the biceps, lev scap and supraspinatus tender points and their release. patient on the back, for biceps release flex shoulder, elbow flexion, external rotation, put the back of the hand on the forehead of the patients head. press on biceps tendon. supraspinatus - upper extremity 45 degrees abduction, 45 degrees flexion and external rotation. push on the upper extremity superiorly. for lev scap abduct the upper extremity and shorten the lev scap by pushing on the upper extremity superiorly.
25.2.2013 Lecture no.4 - recap
We went through all the techniques we learned over last three lectures. It was very beneficial to clarify some points we were not sure about and we also talked about the cases when we used strain counterstrain techniques in the clinic. I experienced a patient with recurrent lower back pain with very tight iliopsoas so i tried technique on him and while pressing on the spot just 1cm medially off the ASIS, i could feel a lot of twitching. Not sure if he was better as he never came back :-( but i used it on my acute friend too and it helped her a lot.